Renal transplant
Clinical Procedure
 
Aliases:
Kidney transplant

Topic aliases are alternate phrasings for a particular topic.


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Electrolytes taken immediately post dialysis are unreliable

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Ensure optimal preoperative condition to improve patient and organ outcome. K<5.5, BSL <15mmol/L, euvolaemic.

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Jun 12, 2011
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Read the admission notes from renal physicians. They may have advice on the patient's current fluid status and likely intraoperative fluid requirements.

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Duration 2-4 hrs

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Jun 22, 2011
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Central venous-line may help guide volume replacement. Aim for a high normal intravascular volume state.

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If the patient is undergoing peritoneal dialysis with no arteriovenous fistula, a permacath may be inserted if the kidney isn't expected to function immediately. Place CVC in area away from planned permacath insertion site

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Intra-arterial blood pressure monitoring will be required to monitor perfusion pressures in the newly transplanted kidney.

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Avoid nephrotoxic drugs ( NSAIDS, Gentamicin)

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Patient controlled analgesia (PCA) with fentanyl

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Morphine depends on renal excretion which will still be impaired in the immediate postoperative period
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If the patient's current weight is more than 2kg above their dry weight, the patient may already be at the upper limit of intravascular volume. Be cautious with intraoperative fluid administration.

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Aim for a high normal intravascular volume by the time the transplant kidney is about to be reperfused. Take several variables into account, including swinging of the arterial and central trace, and arterial and central pressures

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